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NASA NTRS2010

Advanced Technology Applications for Combat Casualty Care

Exploration Medical Capability (ExMC) is an element of NASA s Human Research Program (HRP). ExMC s goal is to address the risk of the "Inability to Adequately Recognize or Treat an Ill or Injured Crewmember." This poster highlights the approach ExMC has taken to address this goal and our current areas of interest. The Space Medicine Exploration Medical Condition List (SMEMCL) was created to identify medical conditions of concern during exploration missions. The list was derived from space flight medical incidents, the shuttle medical checklist, the International Space Station medical checklist, and expert opinion. The conditions on the list were prioritized according to mission type by a panel comprised of flight surgeons, physician astronauts, engineers, and scientists. From the prioritized list, the ExMC element determined the capabilities needed to address the medical conditions of concern. Where such capabilities were not currently available, a gap was identified. The element s research plan outlines these gaps and the tasks identified to achieve the desired capabilities for exploration missions.

Watkins, Sharmila↗

NASA NTRS2010

Exploration Medical Capability

Exploration Medical Capability (ExMC) is an element of NASA's Human Research Program (HRP). ExMC's goal is to address the risk of the Inability to Adequately Recognize or Treat an Ill or Injured Crewmember. This poster highlights the approach ExMC has taken to address this goal and our current areas of interest. The Space Medicine Exploration Medical Condition List (SMEMCL) was created to identify medical conditions of concern during exploration missions. The list was derived from space flight medical incidents, the shuttle medical checklist, the International Space Station medical checklist, and expert opinion. The conditions on the list were prioritized according to mission type by a panel comprised of flight surgeons, physician astronauts, engineers, and scientists. From the prioritized list, the ExMC element determined the capabilities needed to address the medical conditions of concern. Where such capabilities were not currently available, a gap was identified. The element s research plan outlines these gaps and the tasks identified to achieve the desired capabilities for exploration missions. This poster is being presented to inform the audience of the gaps and tasks being investigated by ExMC and to encourage discussions of shared interests and possible future collaborations.

Watkins, Sharmila↗

NASA NTRS2012

Exploration Laboratory Analysis - ARC

The Exploration Laboratory Analysis (ELA) project supports the Exploration Medical Capability (ExMC) risk, Risk of Inability to Adequately Treat an Ill or Injured Crew Member, and ExMC Gap 4.05: Lack of minimally invasive in-flight laboratory capabilities with limited consumables required for diagnosing identified Exploration Medical Conditions. To mitigate this risk, the availability of inflight laboratory analysis instrumentation has been identified as an essential capability in future exploration missions. Mission architecture poses constraints on equipment and procedures that will be available to treat evidence-based medical conditions according to the Space Medicine Exploration Medical Conditions List (SMEMCL). The SMEMCL provided diagnosis and treatment for the evidence-based medical conditions and hence, a basis for developing ELA functional requirements.

Krihak, Michael K.↗

NASA NTRS2014

Identification of Medical Training Methods for Exploration Missions

As the National Aeronautics and Space Administration (NASA) and its international partner agencies anticipate eventual exploration missions of longer duration, there is a need to plan for the medical capabilities necessary to maximize crew health and provide the best likelihood of mission success. Current spaceflights consist of 5- to 6-month excursions to the International Space Station (ISS) in low-Earth orbit (LEO), and a 12-month ISS mission is currently in planning stages. However, missions to a near-Earth asteroid (NEA), a return to the moon, or even a mission to Mars will demand unprecedented medical capabilities, particularly relating to the training of the crew medical officers (CMOs). In its attempts to address the questions about medical preparation for spaceflight beyond LEO, the Exploration Medical Capability (ExMC) element within NASA's Human Research Program (HRP) defines a series of gaps. These gaps are shortcomings in knowledge, training, or technology that require resolution before an exploration mission can be undertaken. The ExMC element maintains current information about measures to close these gaps while developing plans for further investigation and research. Data pertaining to the gaps and their present status are available to the general public on the NASA Human Research Wiki and the NASA Human Research Roadmap Web sites (34, 36). One such gap, Gap 3.01, identifies a lack of knowledge about the optimal training methods for in-flight medical conditions identified on the Exploration Medical Condition List (EMCL), taking into account the crew medical officer s (CMOs) clinical background (33). This broad statement encompasses several related issues with the current methods of training CMOs and the medical ground support staff, specifically flight surgeons and biomedical engineers (BMEs) located in mission control, in addition to questions pertaining to the ways in which training will need to be adapted for the medical contingencies unique to exploration missions. To determine the optimal methods of medical training for an exploration medical crew and their ground support team, the historical context of medical operations, the current CMO training methods, and potential alternative training methods were identified.

Long duration space flight↗

NASA NTRSDate not supplied

Candidate Formulary Development for Exploration Missions

An interdisciplinary team of clinician, pharmacist, and system engineer subject matter experts (SMEs) collaborated to match pharmaceutical resources to the medical conditions anticipated to occur during exploration class missions. This effort began by using a SME generated Exploration Medical Conditions List and the associated medical system capabilities necessary to treat them. Using the systems engineering software MagicDraw™ and knowledge of pharmaceutical use and efficacy in spaceflight, the team traced appropriate medications to the medical conditions. These traces were used to pilot the process for generating a candidate formulary for level of care 4 and level of care 5 medical systems. This presentation will discuss the collaborative efforts of the team as they developed the content, detail the challenges of utilizing systems engineering software to describe clinical resources, and provide an overview of how the candidate medication formulary for exploration class missions was developed. It will also discuss how the lessons learned from this pilot effort can be applied to streamline future work.

S. Kurian↗

NASA NTRS2023

IMPACTing Medical System Design with a Risk Analysis Tool [“IMPACT” sur la Conception du Système Médical avec un Outil d'Analyse des Risques]

Background: Following the success of Artemis I, NASA is preparing for human extended duration missions. Ongoing efforts are focused on mitigating mission-related risks, including those affecting crew health and performance. Communication latency, logistics of resupply and time frame of medical evacuation are barriers to provision of healthcare for these missions, especially with respect to constraints in mass, volume, and crew training. An in-depth assessment of medical risks, capabilities and resources for a specific mission design is necessary to determine an optimal balance that maximizes likelihood of mission success. Overview: IMPACT (Informed Mission Planning via Analysis of Complex Tradespaces) is a dynamic tool designed to estimate medical risk and outcomes for a specific mission design. In its current iteration, a list of medical conditions selected based on likelihood of occurrence and/or consequence was linked to a set of clinical capabilities and resources necessary for diagnosis and management. A probabilistic risk analysis tool was then used to identify and estimate the likelihood and consequence of risks through the following outcome metrics: loss of crew life (inflight mortality due to medical conditions), need for medical evacuation (return to definitive care), and crew disability (task time affected based on how medical conditions influence the ability to perform specific exploration mission crew tasks). Finally, the model’s optimization algorithm provides recommendations for medical capabilities that maximize risk mitigation relative to mass and volume constraints. In the Spring of 2023, IMPACT was utilized to estimate outcome metrics for a design reference mission that would be representative of an extended duration Artemis mission. Notional data generated were then used to determine a recommended set of medical capabilities and resources relative to user-defined mass and volume constraints. A multidisciplinary team has also been updating IMPACT to strengthen the model’s fidelity. Figure 1 shows how updates to outcome metric inputs for the conditions resulted in different capability and resource allocation recommendations. Discussion: This presentation will discuss the IMPACT tool and share the latest data generated for a representative extended duration Artemis mission. Efforts to improve the fidelity of data generated by the model’s algorithm will also be discussed.

K A Shair↗

NASA NTRSDate not supplied

IMPACTing Medical System Design with a Risk Analysis Tool

K A Shair↗

NASA NTRS2024

ISS Technology Demonstrations for Future Spaceflight Medical Systems

Throughout the history of human spaceflight, crewmembers have experienced various in-flight medical conditions including illness and injury. Planned missions to the Moon and Mars will require capabilities to maintain the health of future space travelers. Mass, power, and volume available in the vehicles and habitats for these missions will be severely constrained; resupply of resources will be limited or non-existent, as will opportunities for evacuation to Earth. Furthermore, ground-based support will be hampered by communication latencies and blackouts. These vehicle and mission constraints will necessitate a medical system that has been efficiently planned, providing on-board procedural guidance in addition to a variety of medical devices and consumable resources. Medical capabilities required for the diagnosis and treatment of potential medical conditions during future spaceflight missions may include real-time health monitoring, medical imaging, and biomarker analyses ( e.g., blood or urine). Terrestrial medicine shares these needs, thus many of these medical capabilities could likely be satisfied by Commercial-Off-The-Shelf (COTS) devices and methodologies; however, in some cases the unique space environment and increased mission duration will drive the need to modify technologies and the way care is provided. NASA’s Human Research Program (HRP) Exploration Medical Capability (ExMC) Element and Mars Campaign Office’s Exploration Medical Integrated Product Team (XMIPT) are working together to decrease medical risk during exploration missions. Flight-tested medical diagnostic and treatment technologies are necessary to effectively manage medical conditions relevant to exploration missions while meeting vehicle constraints, integrating with medical decision-support tools, and enabling increasingly Earth-independent operations. Several projects have leveraged the ISS as a testbed for exploration, including 1) i n- situ blood analysis, 2) medical inventory, 3) intravenous fluid generation, and 4) autonomous medical procedure guidance. Management of several in-flight medical conditions, such as bacterial and viral infections and acute radiation syndrome, is dramatically improved with ability to assess blood cell populations, electrolytes, and metabolites. I n December 2020 and January 2021 ExMC performed an ISS technology demonstration (Tech Demo) of the HemoCue® WBC DIFF analyzer (HemoCue, Brea, CA), a COTS device that was modified to enable functionality in a spaceflight environment. This Tech Demo marked the first time that hematology measurements were successfully performed real-time in microgravity. Also modified and demonstrated was the reusable Handheld Electrolytes and Lab Technology for Humans (rHEALTH) ONE analyzer (rHEALTH, Bedford, MA), which uses flow cytometry and sheath-based hydrodynamic focusing methodologies. The rHEALTH ONE ISS Tech Demo in May 2022 demonstrated test results obtained in-flight matched those on the ground. NASA currently relies on crew self-reporting to manage and maintain medical inventory on ISS.The ability to maintain an accurate inventory becomes more critical during long duration missions since the crew will need to be increasingly autonomous in finding and utilizing medical items, including those scenarios when alternative treatments need to be considered due to limited or no resupply. HRP’s Medical Consumables Tracking (MCT) project was developed by ZIN Technologies, Inc. (Cleveland, OH), and demonstrated real-time tracking of medical supplies aboard the ISS between December 2016 and July 2018. The MCT system design utilized Radio Frequency Identification Device (RFID) technology to perform automated inventory and was installed in the Crew Health Care System (CHeCS) Resupply Stowage Rack (RSR). The challenge of limited shelf life, exacerbated by the lack of resupply opportunities, affects a plethora of medical system components including consumables, pharmaceuticals, and intravenous (IV) fluid. In 2010, ExMC funded ZIN Technologies, Inc. (Cleveland, OH), to develop the Intravenous Fluid Generation (IVGEN) system. IV fluids were successfully generated with IVGEN using the potable water supply on ISS during ISS Expedition 23. The XMIPT is in the process of developing a miniaturized version of the original IVGEN hardware for a future Tech Demo aboard the ISS. Current ISS medical operations rely heavily on preflight training and real-time remote guidance, both of which become impractical or impossible for exploration missions. The primary goal of the Autonomous Medical Officer Support (AMOS) Software Tech Demos on ISS was to confirm telemedical proof-of-concept for autonomous medical imaging in an operational setting. This novel software tool shifts emphasis from preflight training and real-time remote guidance to in-flight just-in-time instruction, a new and necessary paradigm for crew medical autonomy. AMOS introduces a novel, streamlined skill management concept for exploration missions featuring comprehensive training and guidance modules for ultrasound examinations using the ISS Ultrasound 2 (a modified GE Vivid-q™; General Electric HealthCare, Chicago, IL). With no prior crew training or remote guidance, two Tech Demos on the ISS (April 2020 and June 2022) resulted in high quality, clinically useful image sets. We will provide a review of historical, current, and planned medical devices and technologies considered for inclusion within future spaceflight medical systems and summarize hardware development activities and medical device tech demos conducted on the ISS.

Astronaut health and performance↗

NASA NTRSDate not supplied

Introduction to the IMPACT Probabilistic Risk and Tradespace Analysis Tool for Medical System Design

Background: Probabilistic risk analysis (PRA) is a method for estimating risk in complex engineered systems that, at a basic level, focuses on what can go wrong and the likelihood and consequences of those occurrences. NASA has used PRA as an integral component of medical system risk estimation and design for spaceflight. IMPACT (Informing Mission Planning via Analysis of Complex Tradespaces) is a novel tool to meet these goals for exploration missions. Overview: IMPACT performs hundreds of thousands of Monte Carlo simulations of missions to build aggregate pictures of medical risk. These simulations are based on 120 possible medical conditions (the IMPACT Condition List) selected in a consensus-based process because they are of highest likelihood and/or consequence for exploration spaceflight. The conditions are then tied to clinical capabilities which can be used for management (e.g., inserting an IV) and then to over 600 specific resources needed to deliver a capability (e.g., an angiocath or an ultrasound). Different mission profiles can be simulated with user-specified inputs such as mission duration, destination, number of crew and pre-existing medical conditions, and EVA frequency. While the IMPACT evidence base is designed for exploration environments, these user inputs allow the tool to be used across a broad range of missions. IMPACT’s primary outcome metrics include loss of crew life (LOCL, a measure of in-flight mortality due to medical conditions), need for evacuation (RTDC, return to definitive care), and crew disability (TTL, task time lost based on how medical conditions impact the ability to perform over 1000 specific exploration mission crew tasks). In addition to modeling medical risk, IMPACT also accepts user-specified constraints, such as limitations of mass or volume, and will output a recommended clinical capability set and specific medical resources that meet the mission constraints. Discussion: This abstract will provide an introduction to IMPACT and describe the nature of the underlying medical evidence. It will also detail potential use cases for how this tool can be utilized by NASA or commercial spaceflight providers.

Ben Easter↗

NASA NTRS2009

The Integrated Medical Model: A Risk Assessment and Decision Support Tool for Space Flight Medical Systems

The Integrated Medical Model (IMM) is a decision support tool that is useful to mission planners and medical system designers in assessing risks and designing medical systems for space flight missions. The IMM provides an evidence based approach for optimizing medical resources and minimizing risks within space flight operational constraints. The mathematical relationships among mission and crew profiles, medical condition incidence data, in-flight medical resources, potential crew functional impairments, and clinical end-states are established to determine probable mission outcomes. Stochastic computational methods are used to forecast probability distributions of crew health and medical resource utilization, as well as estimates of medical evacuation and loss of crew life. The IMM has been used in support of the International Space Station (ISS) medical kit redesign, the medical component of the ISS Probabilistic Risk Assessment, and the development of the Constellation Medical Conditions List. The IMM also will be used to refine medical requirements for the Constellation program. The IMM outputs for ISS and Constellation design reference missions will be presented to demonstrate the potential of the IMM in assessing risks, planning missions, and designing medical systems. The implementation of the IMM verification and validation plan will be reviewed. Additional planned capabilities of the IMM, including optimization techniques and the inclusion of a mission timeline, will be discussed. Given the space flight constraints of mass, volume, and crew medical training, the IMM is a valuable risk assessment and decision support tool for medical system design and mission planning.

Kerstman, Eric↗

NASA NTRS2014

NASA Laboratory Analysis for Manned Exploration Missions

The Exploration Laboratory Analysis (ELA) project supports the Exploration Medical Capability Element under the NASA Human Research Program. ELA instrumentation is identified as an essential capability for future exploration missions to diagnose and treat evidence-based medical conditions. However, mission architecture limits the medical equipment, consumables, and procedures that will be available to treat medical conditions during human exploration missions. Allocated resources such as mass, power, volume, and crew time must be used efficiently to optimize the delivery of in-flight medical care. Although commercial instruments can provide the blood and urine based measurements required for exploration missions, these commercial-off-the-shelf devices are prohibitive for deployment in the space environment. The objective of the ELA project is to close the technology gap of current minimally invasive laboratory capabilities and analytical measurements in a manner that the mission architecture constraints impose on exploration missions. Besides micro gravity and radiation tolerances, other principal issues that generally fail to meet NASA requirements include excessive mass, volume, power and consumables, and nominal reagent shelf-life. Though manned exploration missions will not occur for nearly a decade, NASA has already taken strides towards meeting the development of ELA medical diagnostics by developing mission requirements and concepts of operations that are coupled with strategic investments and partnerships towards meeting these challenges. This paper focuses on the remote environment, its challenges, biomedical diagnostics requirements and candidate technologies that may lead to successful blood-urine chemistry and biomolecular measurements in future space exploration missions.

Laboratory Analysis↗

NASA NTRS2013

Exploration Laboratory Analysis FY13

The Exploration Laboratory Analysis (ELA) project supports the Exploration Medical Capability (ExMC) risk, which is stated as the Risk of Inability to Adequately Treat an Ill or Injured Crew Member, and ExMC Gap 4.05: Lack of minimally invasive in-flight laboratory capabilities with limited consumables required for diagnosing identified Exploration Medical Conditions. To mitigate this risk, the availability of inflight laboratory analysis instrumentation has been identified as an essential capability in future exploration missions. Mission architecture poses constraints on equipment and procedures that will be available to treat evidence-based medical conditions according to the Space Medicine Exploration Medical Conditions List (SMEMCL), and to perform human research studies on the International Space Station (ISS) that are supported by the Human Health and Countermeasures (HHC) element. Since there are significant similarities in the research and medical operational requirements, ELA hardware development has emerged as a joint effort between ExMC and HHC. In 2012, four significant accomplishments were achieved towards the development of exploration laboratory analysis for medical diagnostics. These achievements included (i) the development of high priority analytes for research and medical operations, (ii) the development of Level 1 functional requirements and concept of operations documentation, (iii) the selection and head-to-head competition of in-flight laboratory analysis instrumentation, and (iv) the phase one completion of the Small Business Innovation Research (SBIR) projects under the topic Smart Phone Driven Blood-Based Diagnostics. To utilize resources efficiently, the associated documentation and advanced technologies were integrated into a single ELA plan that encompasses ExMC and HHC development efforts. The requirements and high priority analytes was used in the selection of the four in-flight laboratory analysis performers. Based upon the competition results, a down select process will be performed in the upcoming year. Looking ahead, this unified effort has positioned each element for an in-flight lab analysis demonstration of select diagnostics measurements in the 2015 timeframe.

Krihak, Michael↗

NASA NTRS2013

Intravenous Fluid Generation System

The ability to stabilize and treat patients on exploration missions will depend on access to needed consumables. Intravenous (IV) fluids have been identified as required consumables. A review of the Space Medicine Exploration Medical Condition List (SMEMCL) lists over 400 medical conditions that could present and require treatment during ISS missions. The Intravenous Fluid Generation System (IVGEN) technology provides the scalable capability to generate IV fluids from indigenous water supplies. It meets USP (U.S. Pharmacopeia) standards. This capability was performed using potable water from the ISS; water from more extreme environments would need preconditioning. The key advantage is the ability to filter mass and volume, providing the equivalent amount of IV fluid: this is critical for remote operations or resource- poor environments. The IVGEN technology purifies drinking water, mixes it with salt, and transfers it to a suitable bag to deliver a sterile normal saline solution. Operational constraints such as mass limitations and lack of refrigeration may limit the type and volume of such fluids that can be carried onboard the spacecraft. In addition, most medical fluids have a shelf life that is shorter than some mission durations. Consequently, the objective of the IVGEN experiment was to develop, design, and validate the necessary methodology to purify spacecraft potable water into a normal saline solution, thus reducing the amount of IV fluids that are included in the launch manifest. As currently conceived, an IVGEN system for a space exploration mission would consist of an accumulator, a purifier, a mixing assembly, a salt bag, and a sterile bag. The accumulator is used to transfer a measured amount of drinking water from the spacecraft to the purifier. The purifier uses filters to separate any air bubbles that may have gotten trapped during the drinking water transfer from flowing through a high-quality deionizing cartridge that removes the impurities in the water before entering the salt bag and mixing with the salt to create a normal saline solution.

McQuillen, John↗

NASA NTRS2023

Exploration Medical Capability IMPACT Medical Database – Medical Item Database (MedID) Content Development Methods

The Informing Mission Planning via Analysis of Complex Tradespaces (IMPACT) project encompasses a suite of computational tools that are used to inform systematic trade study evaluations and research prioritizations regarding the optimization of spaceflight medical systems, including the provision of risk assessment metrics, for a given design reference mission (DRM). The IMPACT Medical Database (IMPACT-MD) is the component that virtually houses the clinical and engineering data for medical conditions, capabilities, and resources used to support these analyses. In addition, IMPACT-MD also provides data to the associated SysML model to support the Level 2, Level 3, and Level 4 requirements development needed for IMPACT. IMPACT-MD contains an internal Evidence Library (EL) sub-component that hosts the clinical evidence, treatment and outcome metric data, and incidence data for each medical condition identified for exploration-class missions. Furthermore, a separate Medical Item Database (MedID) sub-component hosts the engineering data and physical attributes (e.g., mass, volume, power, etc.) associated with each medical resource item identified to address the requisite medical conditions. The IMPACT project is conducted under the Exploration Medical Capability (ExMC) element of the Human Research Program (HRP) within NASA's Space Operations Mission Directorate (SOMD). The reader is referred to the documents in Appendix A for a more complete overview of the IMPACT tool suite and functionality as well as further detail on any associated aspects of the project. The primary purpose of this document is to describe the methods utilized in the collection and verification of engineering data content during the project development phase for the MedID sub-component of the IMPACT-MD project. Engineering content data (both existing and new/future) will be stored in IMPACT-MD for use by the IMPACT project. This document will detail the content development and data credibility for the engineering data housed within the MedID subcomponent of IMPACT-MD, which is used to inform the IMPACT 1.0 project deliverables.

Exploration Medical Capability↗

NASA NTRSDate not supplied

Artificial Intelligence (AI) Methods for Automating the Impact Tool Evidence Library

INTRODUCTION: The development of the Evidence Library for use with the IMPACT (Informing Mission Planning via Analysis of Complex Tradespaces) probability risk assessment tool involved a multilayered, time intensive process of data collection and analysis by subject matter experts from the Exploration Medical Capability (ExMC) Element Clinical and Science Team to produce clinical findings forms (CliFFs) for 120 medical conditions. Artificial Intelligence Large Language Models (LLMs) can be leveraged to facilitate this process, thus reducing labor and time. TOPIC: CliFFs contain information about medical conditions as they pertain to spaceflight. This includes condition definitions, incidence data, crew task impairment estimates caused by conditions, treatment protocols and references to literature used for gathering condition evidence. Guided by the Evidence Library Methods document and the CliFF development instructions, a team has leveraged Microsoft Azure AI services and open-source documentation to construct an AI-assisted automated pipeline for CliFF development. This process is designed to search, retrieve, and evaluate the applicable data, and ultimately generate a completed CliFF. The LLM evaluates the relevance of each of the source materials to spaceflight, either as direct evidence or as an analog. The model extracts keywords and generates brief summaries to enhance search and retrieval in later stages of CliFF development. For instance, it can calculate epidemiological statistical data, such as incidence rates and the likelihood of best or worst-case scenarios. APPLICATION: Large Language Models (LLMs) can efficiently summarize large amounts of text. Leveraging this technology will automate data retrieval and evidence gathering for medical databases, like the IMPACT tool, by aiding in the labor-intensive process of analyzing large bodies of literature and organizing it into a formatted document like a CliFF. This added efficiency will enable expeditious expansion of the Evidence Library with additional medical conditions and update previous CLiFFs as new technology becomes available.

Ali Al↗

NASA NTRSDate not supplied

Crowd Sourcing Medical Data Collection Using Medical Students

OBJECTIVE We undertook an upgrade of the Evidence Library database of NASA HRP’s Integrated Medical Model, assessing 120 medical conditions which integrate with a novel probabilistic risk assessment (IMPACT) tool of medical risk and resource utilization for long duration exploration human spaceflight. This data collection process included a selection of these conditions crowd sourced over one year via three 4-week medical student electives at the University of Colorado School of Medicine (IDPT 8059 Space Medicine: Human Spaceflight Factors & Medical Risk Assessment). Students undertook a rapid systematic review of each medical condition, under close preceptors with backgrounds in clinical medicine, library science, epidemiology, biostatistics, and evidence-based medicine. As part of the elective, students also received instruction in core space medicine concepts, evidence based medicine and problem based learning sessions as a flight surgeon supporting a simulated Mars mission. METHODS The list of 120 medical conditions includes both common, terrestrial illness/injury (epistaxis, diverticulitis) as well as spaceflight-specific ones (space adaptation conditions, EVA-related injuries). A rapid systematic review process was developed that would allow students to find the data for determining disease incidence/prevalence, return to definitive care (often a surrogate such as hospitalization rates), loss of crew life, and treatment duration. Each data point required a tailored, specialized search process using different databases and corresponding specialized search filters. Databases were selected on their ability to provide high quality literature in an efficient manner and prioritized by their ability to provide graded evidence via a set rubrics specific to human spaceflight. Students were responsible for performing all literature searches and identifying the highest quality available evidence for each data point. Completed student data sheets underwent initial review by faculty preceptors followed by a secondary editing review by the ExMC Clinical Science Team. RESULTS Over the course of three electives, approximately 105 medical conditions were researched by students using spreadsheets with pre-crafted search strategies. Overall, this process was successful in allowing students to perform the preponderance of work to update incidence, treatment duration, return to definitive care, and loss of crew life data points. Students were successful in running searches, identifying the necessary data points within the literature, and determining the types of terrestrial data that most aligns with the astronaut population for successful completion of their tasks. Limitations included variable student experience with search methodologies [PubMed], differing values of evidence grading [best practice evidence based medicine vs. relevant to spaceflight], and students’ unfamiliarity with spaceflight specific conditions. CONCLUSION Finding the relevant literature for medical conditions in spaceflight within terrestrial databases in a systematic method is time consuming and not intuitive. However, the stepwise process that balanced sensitivity with specificity allowed for students to be highly successful in a short amount of time. Additionally, as the process was refined over the course of three electives, preceptors were better able to anticipate where students were likely to encounter barriers, which allowed the course to be adjusted to account for certain data points needing more time for completion. This replicable process may be an efficient way to accomplish rapid systematic reviews for a large volume of data in a short amount of time.

J Lemery↗

NASA NTRS2023

Intravenous Fluid Generation Mini (IVGEN Mini) Summary and Related Research

This paper assists the ongoing effort to support NASA Glenn’s mission and its Human Research Program (HRP) core competency by investigating a technology demonstration to mitigate human health and performance risks during space exploration. Crew health and performance are critical to successful human exploration beyond low Earth orbit. Four hundred forty-two medical conditions have been identified and may present and require treatment during long-duration space exploration missions. One hundred fifteen out of four hundred forty-two identified medical conditions would require medical fluid treatment, generating a need for an on-demand or continuous supply of medical fluid. Intravenous Fluid Generation Mini (IVGEN Mini) is a technology demonstration designed to demonstrate a water purification and pharmaceutical mixing system that can make intravenous (IV) fluid in microgravity and builds on the success of the original Intravenous Fluid Generation for Exploration Missions (IVGEN) experiment, which flew on the ISS in March 2010. IVGEN Mini seeks to increase the Technology Readiness Level (TRL) and the overall function of the original IVGEN experiment to reduce the dependence of a needed medical consumable and streamline the size of the device and process to generate IV fluid IVGEN Mini is funded by the Advanced Exploration Systems (AES) directorate via the Exploration Medical Integrated Product Team (XMIPT) as a part of their mission to advance exploration medical technologies to benefit the overall health and safety of crews for beyond low Earth orbit space missions. This paper discusses a collection of related research topics such as microgravity fluid mixing and studying past efforts of IV fluid usage in extreme environments to aid IVGEN Mini project scientists in developing the IVGEN Mini technology.

iv generation↗

NASA NTRS2018

Validation of the Nasa Integrated Medical Model: a Space Flight Medical Risk Prediction Tool

The Human Research Program funded the development of the Integrated Medical Model (IMM) to quantify the medical component of overall mission risk. The IMM uses Monte Carlo simulation methodology, incorporating space flight and ground medical data, to estimate the probability of mission medical outcomes and resource utilization. To determine the credibility of IMM output, the IMM project team completed two validation studies that compared IMM predicted output to observed medical events from a selection of Shuttle Transportation System (STS) and International Space Station (ISS) missions. The validation study results showed that the IMM underpredicted the occurrence of ~10% of the modeled medical conditions for the STS missions and overpredicted ~20% of the modeled medical conditions for the ISS missions. These findings imply that the strength of IMM predictions to inform decisions depends on simulated mission specifications including length. This discrepancy could result from medical recording differences between ISS and STS that possibly influence observed incidence rates, IMM combining all "mission type" data as constant occurrence rate or fixed proportion across both mission types, misspecification of symptoms to conditions, and gaps in the literature informing the model. Some of these issues will be alleviated by updating the IMM source data through incorporation of the observed validation data.

medical equipment↗